Relational autonomy in the clinical encounter: Female genital cosmetic surgery in Belgium and the Netherlands

While previous research has examined sociocultural influences on women's motivations for FGCS, less attention has been paid to how clinical encounters are experienced and interpreted in relation to genital concerns and decisions about surgery. Data collection was conducted in 2024-2025 in Belgium and the Netherlands and consisted of in-depth interviews with eleven women who had undergone FGCS and twelve clinicians who perform these procedures, supplemented by focus group discussions with 44 women from the general population. Using reflexive thematic analysis, we identified four interrelated patterns: unsolicited clinical remarks that participants experienced as drawing attention to previously unproblematic aspects of their genital appearance; validation of pre-existing concerns that some women seeking FGCS experienced as reinforcing perceptions of abnormality; recommendations that extended existing concerns to additional anatomical features or procedures women had not previously considered; and reassurance about genital diversity and surgical risks that some women described as creating greater space for reflection. The findings suggest that clinical encounters can constitute an important relational context in which meanings of genital normality and abnormality, and, among women seeking FGCS, possible surgical intervention are negotiated. By foregrounding how women experience and interpret these interactions, the paper contributes to debates on autonomy and FGCS and highlights the value of considering the relational conditions in which decisions about surgery are made.